Study: Using anticholinergics for as few as 60 days causes memory problems in older adults


Indiana University



INDIANAPOLIS — Research from the Regenstrief Institute, the Indiana University Center for Aging Research and Wishard-Eskenazi Health on medications commonly taken by older adults has found that drugs with strong anticholinergic effects cause cognitive impairment when taken continuously for as few as 60 days. A similar impact can be seen with 90 days of continuous use when taking multiple drugs with weak anticholinergic effect.

The study of 3,690 older adults is among the first to explore how length of use of this group of drugs affects the brain. The study is available online in advance of publication in a print issue of Alzheimer’s & Dementia, the journal of the Alzheimer’s Association. The research was funded by a grant (R24MH080827) from the National Institute on Aging.

Anticholinergic drugs block acetylcholine, a nervous system neurotransmitter. Drugs with anticholinergic effects are sold over the counter and by prescription. Older adults commonly use over-the-counter drugs with anticholinergic effects as sleep aids and to relieve bladder leakage. Drugs with anticholinergic effects are frequently prescribed for many chronic diseases including hypertension, cardiovascular disease and chronic obstructive pulmonary disease.

A list of drugs noting their anticholinergic burden can be found on the Aging Brain Care website.

The Regenstrief Institute, IU Center for Aging Research and Wishard-Eskenazi Health researchers reported that continuously taking strong anticholinergics, like many sleeping pills or antihistamines, for only 60 days caused memory problems and other indicators of mild cognitive impairment. Taking multiple drugs with weaker anticholinergic effects, such as many common over-the-counter digestive aids, had a negative impact on cognition in 90 days.

“We found that a high anticholinergic burden — either from one or multiple drugs — plus two to three months of continuous exposure to that high burden approximately doubled the risk of developing cognitive impairment,” said Noll Campbell, Pharm.D., study co-author and Regenstrief Institute investigator. “Millions of older adults are taking sleeping pills or prescription drugs year after year that may be impacting their organizational abilities and memory.”

Dr. Campbell is also an IU Center for Aging Research scientist, a research assistant professor in the Department of Pharmacy Practice, Purdue University College of Pharmacy, and a clinical pharmacy specialist in geriatrics with Wishard-Eskenazi Health Services.

“While the link between anticholinergics and cognitive impairment has been reported by our group and others, the cumulative burden of anticholinergics was rather unexpected, as was the lack of a clear association between anticholinergic burden and dementia,” said Regenstrief Institute investigator Malaz Boustani, M.D., MPH. Dr. Boustani, the senior author of the study, who is also associate director of the IU Center for Aging Research and an associate professor of medicine at IU School of Medicine. He sees patients at the Healthy Aging Brain Center at Wishard-Eskenazi Health.

“The fact that taking anticholinergics is linked with mild cognitive impairment, involving memory loss without functional disability, but not with Alzheimer’s disease and other dementing disorders, gives hope. Our research efforts will now focus on whether anticholinergic-induced cognitive impairment may be reversible,” Dr. Boustani said.


In addition to Drs. Campbell and Boustani, co-authors of “Long-term anticholinergic use and the aging brain” are Xueya Cai, Ph.D., formerly of the IU School of Medicine and now with the University of Rochester; Regenstrief investigator Babar Khan, M.D., IU Center for Aging Research scientist and IU School of Medicine assistant professor of medicine; and Regenstrief investigator Christopher Callahan, M.D., founding director of IU Center for Aging Research and Cornelius and Yvonne Pettinga Professor in Aging Research at the IU School of Medicine. Drs. Boustani, Kahn and Callahan see patients at Wishard-Eskenazi Health.

Alzheimer’s disease may protect against cancer and vice versa

2009 study posted for filing

Contact: Rachel Seroka 651-695-2738 American Academy of Neurology

ST. PAUL, Minn. – People who have Alzheimer’s disease may be less likely to develop cancer, and people who have cancer may be less likely to develop Alzheimer’s disease, according to a new study published in the December 23, 2009, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Discovering the links between these two conditions may help us better understand both diseases and open up avenues for possible treatments,” said study author Catherine M. Roe, PhD, of Washington University School of Medicine in St. Louis, MO, and a member of the American Academy of Neurology.

For the study, researchers looked at a group of 3,020 people age 65 and older who were enrolled in the Cardiovascular Health Study and followed them for an average of five years to see whether they developed dementia and an average of eight years to see whether they developed cancer. At the start of the study, 164 people (5.4 percent) already had Alzheimer’s disease and 522 people (17.3 percent) already had a cancer diagnosis.

During the study, 478 people developed dementia and 376 people developed invasive cancer. For people who had Alzheimer’s disease at the start of the study, the risk of future cancer hospitalization was reduced by 69 percent compared to those who did not have Alzheimer’s disease when the study started. For Caucasian people who had cancer when the study started, their risk of developing Alzheimer’s disease was reduced by 43 percent compared to people who did not have cancer at the start of the study, although that finding was not evident in minority groups.


The study was supported by the National Institutes of Health, the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, the National Center for Research Resources, and the Washington University Alzheimer’s Disease Research Center.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit




Commonly used medications may produce cognitive impairment in older adults:

2009 study posted for filing

Contact: Cindy Fox Aisen
Indiana University

Drugs, such as diphenhydramine, which have an anticholinergic effect, are important medical therapies available by prescription and also are sold over the counter under various brand names such as Benadryl®, Dramamine®, Excederin PM®, Nytol®, Sominex®, Tylenol PM®, and Unisom®. Older adults most commonly use drugs with anticholinergic effects as sleep aids.INDIANAPOLIS – Many drugs commonly prescribed to older adults for a variety of common medical conditions including allergies, hypertension, asthma, and cardiovascular disease appear to negatively affect the aging brain causing immediate but possibly reversible cognitive impairment, including delirium, in older adults according to a clinical review now available online in the Journal of Clinical Interventions in Aging, a peer reviewed, open access publication.

While it is known that these medications do have an effect on the brain and in the case of sleeping pills, are prescribed to act on the brain, the study authors suggest the amount of cognitive impairment caused by the drugs in older adults is not well recognized.

“The public, physicians, and even the Food and Drug Administration, need to be made aware of the role of these common medications, and others with anticholinergic effects, in causing cognitive impairment. Patients should write down and tell their doctor which over-the-counter drugs they are taking. Doctors, who often think of these medications simply as antihistamines, antidepressants, antihypertensives, sleep aids or even itching remedies, need to recognize their systemic anticholinergic properties and the fact that they appear to impact brain health negatively. Doing so, and prescribing alternative medications, should improve both the health and quality of life of older adults,” said senior study author Malaz Boustani, M.D., Indiana University School of Medicine associate professor of medicine, Regenstrief Institute investigator, and research scientist with the IU Center for Aging Research.

Dr. Boustani and colleagues conducted a systematic evidence-based analysis of 27 peer reviewed studies of the relationship of anticholinergic effect and brain function as well as investigating anecdotal information. They found a strong link between anticholinergic effect and cognitive impairment in older adults.

“One of the goals of our work is to encourage the Food and Drug Administration to expand its safety evaluation process from looking only at the heart, kidney and liver effects of these drugs to include effects of a drug on the most precious organ in human beings, our brain,” Dr. Boustani said.

“Many medications used for several common disease states have anticholinergic effects that are often unrecognized by prescribers” said Wishard Health Services pharmacist, Noll Campbell, Pharm.D., first author of the study, noting that these drugs are among the most frequently purchased over the counter products. “In fact, 50 percent of the older adult population use a medication with some degree of anticholinergic effect each day.”

“Our main message is that older adults and their physicians should have conversations about the benefits and harms of these drugs in relation to brain health. As the number of older adults suffering from both cognitive impairment and multiple chronic conditions increases, it is very important to recognize the negative impact of certain medications on the aging brain,” said Dr. Boustani.

The brain pharmacoepidemiology group of the IU Center for Aging Research currently is conducting a study of 4,000 older adults to determine if the long term use of medications with anticholinergic effects is linked to the irreversible development of cognitive impairment such as Alzheimer disease.


Authors of the JCIA study are Noll Campbell, Pharm.D., Wishard Health Services; Malaz Boustani, M.D., MPH; Tony Limbil, M.D., MPH, of University of Illinois; Carol Ott, Pharm.D. of Wishard and Purdue University; Chris Fox, MRCPsych and Ian Maidment, B.Pharm., of Kent Institute of Medicine and Health Sciences University of Kent and Medway NHS Trust, United Kingdom; Cathy C. Schubert, M.D. of the IU School of Medicine; Stephanie Munger, B.S., of Regenstrief and IUCAR; Donna Fick, R.N., Ph.D., of Pennsylvania State University; David Miller, M.D., of the IU School of Medicine and Rajesh Gulati, M.D., of IU Medical Group – Primary Care.

The study was funded by the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation, and the National Institute on Aging

Life expectancy for poor white Americans drops sharply… but increases for blacks and Latinos: •White female high school drop-outs lived to 78.5 years in 1990, 73.5 years in 2008

  • White female high school drop-outs lived to  78.5 years in 1990, 73.5 years in 2008
  • Females who finished college lived for 83.9  years, males for 80.4
  • White males who didn’t finish high school  reached 70.5 years in 1990 and 67.5  2008
  • Black and Latino life expectancy rose,  regardless of education
  • The average Latin American life expectancy  rose 45 years from 29 in 1900, to 74 in 2010
  • American women are now 41st in the world  life expectancy league table
  • They were 14th in 1985

By Daniel Bates

PUBLISHED:10:39 EST, 21  September 2012| UPDATED:11:32 EST, 21 September 2012


Poor white Americans are seeing their life  expectancy decrease in trend that is close to what happened during the collapse  of the Soviet Union.

Researchers have found that white women who  did not finish high school saw the steepest decline and lost five years of their  lives between 1990 and 2008.

White men with a similar education died three  years earlier than they should have over the same period.

Worrying: The life expectancy for poor white Americans has dropped dramaticallyWorrying: The life expectancy for poor white Americans  has dropped dramatically

Worrying trend: Chart shows how the life expectancy of whites without a high school degree has fallen in recent yearsWorrying trend: Chart shows how the life expectancy of  whites without a high school degree has fallen in recent years

Black and Latino men and women, however, all  saw their life expectancy rise.

A similar study, presented by the Pan American Health Organization, found  that the average life expectancy in Latin  America has risen from 29 years in 1900 to 74 years in 2010, Fox News  Latino reported.

The researchers were appalled that in the US,  the richest country in the world, people were living shorter lives and said the  findings were ‘deeply troubling’.


Until now rising life expectancies have been  a given in the developed world and that decreases only happened in war-torn  African countries.

But a combination of unhealthy lifestyles,  obesity and prescription drug overdoses appear to be changing that.

The research found that a lack of education  was the key factor – white women who did not finish high school lived to 78.5  years in 1990 but just 73.5 years in 2008.

By comparison white women who finished  college lived for 83.9 years.

Men saw a drop from 70.5 to 67.5 years over  the same period but when you factor in education, the gap was even  bigger.

School's out: Those who did not finish high school saw the steepest decline in life expectancySchool’s out: Those who did not finish high school saw  the steepest decline in life expectancy

The researchers found that those who finished  college lived for 80.4 years respectively – 13 years more than their less  educated equivalents.

Lead researcher S. Jay Olshansky, a public  health professor at the University of Illinois at Chicago, said that such life  expectancies were on a par with those seen in America in the 1950s and  60.

And at the same time, black men and women- even if they had a poor education – saw their numbers steadily rise.

John Haaga, head of the Population and Social  Processes Branch of the National Institute on Aging, said: ‘We’re used to  looking at groups and complaining that their mortality rates haven’t improved  fast enough, but to actually go backward is deeply troubling’.

The decline has caused America to shoot down  the international league table of life expectancy, the New York  Times reported.

Unhealthy lifestyles: A rising number of obese people is partly to blame for the shift, researchers foundUnhealthy lifestyles: A rising number of obese people is  partly to blame for the shift, researchers found

According to the UN’s Human Mortality  Database, American women were 14th place in 1985 but were in 41st in  2012.

Among developed countries, American women  were bottom.

Michael Marmot, director of the Institute of  Health Equity in London, said that a five year decline in life expectancy was  like what happened in the former Soviet Union when it broke up.

Men lived seven years less on average than  they did before due to rampant alcoholism, high levels of smoking and a  healthcare system that had fallen apart.

Astonishing: A chart by the CDC shows the number of deaths per 100,000 people across the states in 2010 (NB not race-related)Astonishing: A chart by the CDC shows the number of  deaths per 100,000 people across the states in 2010 (NB not  race-related

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Health-care costs at end of life exceed total assets for 25 percent of Medicare population: does not cover co-payments, deductibles, homecare services, or non-rehabilitative nursing home care

Contact: Jeanne Bernard 212-241-9200 The Mount Sinai Hospital / Mount Sinai School of Medicine

As many as a quarter of Medicare recipients spend more than the total value of their assets on out-of-pocket health care expenses during the last five years of their lives, according to researchers at Mount Sinai School of Medicine. They found that 43 percent of Medicare recipients spend more than their total assets minus the value of their primary residences. The findings appear online in the current issue of the Journal of General Internal Medicine.

The amount of spending varied with the patient’s illness. Those with dementia or Alzheimer’s disease spent the most for health care, averaging $66,155, or more than twice that of patients with gastrointestinal disease or cancer, who spent an average of $31,069. Dementia patients often require special living arrangements, which accounts for the sizeable difference in cost.

“Medicare provides a significant amount of health care coverage to people over 65, but it does not cover co-payments, deductibles, homecare services, or non-rehabilitative nursing home care,” said the study’s lead author, Amy S. Kelley, MD, Assistant Professor of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine. “I think a lot of people will be surprised by how high these out-of-pocket costs are in the last years of life.”

The researchers based their findings on 2002-2008 data that was collected from the Health and Retirement Study, a biennial survey of 26,000 Americans over the age of 50, which is supported by the National Institute on Aging, and the Social Security Administration.  They examined 3,209 Medicare recipients during their last five years of life, and compared their out-of-pocket health care expenditures with their total household assets. The study found that the average spending for all participants was $38,688, with more than 75 percent of households spending at least $10,000. The top quarter of participants spent an average of $101,791.

“There are a number of schools of thought on how to rein in Medicare costs, including requiring larger financial contributions from the elderly,” said Dr. Kelley. “Prior to this study there was not a lot of data on the extent of out-of-pocket spending. This information can serve as an important tool to help individuals set realistic expectations for end-of-life health care costs, and for government officials to use in discussing Medicare policies.”




This study was funded by the National Institute on Aging. Dr. Kelley also receives funding from the Hartford Foundation. Researchers from University of California Los Angeles Department of Economics, Dartmouth College Department of Economics, and The Dartmouth Institute for Health Policy and Clinical Practice also contributed to this study.

About The Mount Sinai Medical Center

The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of the leading medical schools in the United States. The Medical School is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by U.S. News & World Report.

The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation’s oldest, largest and most-respected voluntary hospitals. In 2012, U.S. News & World Report ranked The Mount Sinai Hospital 14th on its elite Honor Roll of the nation’s top hospitals based on reputation, safety, and other patient-care factors. Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and by  U.S. News & World Report and whose hospital is on the U.S. News & World Report Honor Roll.  Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.

Healthcare costs hit the elderly hard, diminish financial well being

New York, 4 September 2012

Study finds out-of-pocket spending on healthcare in old age puts significant strain on finances


The protection of the savings of the elderly—one of the primary goals of Medicare—is under threat from a combination of spiraling healthcare costs and increased longevity.  As the government attempts to reduce Medicare costs, one suggestion is that the elderly could pay a larger proportion of the costs of their healthcare.  But exactly how much would this be and what impact would it have on their finances?  A new study by Amy Kelley at the Mount Sinai School of Medicine and her colleagues, funded by the National Institute on Aging, aims to identify the portion of wealth Medicare beneficiaries spend on healthcare costs in the last five years of life.  Their work appears online in the Journal of General Internal Medicine, published by Springer.

Medicare provides nearly universal health care coverage to the population over 65.  However it does not pay for everything.  There are co-payments and deductibles, and more importantly, homecare services and non-rehabilitative nursing home care, which are not covered.  If proposals suggest the elderly should make even larger contributions to care, it is important to know more about patients’ out-of-pocket spending under the current Medicare program.

The authors analyzed data from 3,209 individuals with Medicare coverage included in the Health and Retirement Study (HRS) from 2002-2008.  They measured total out-of-pocket healthcare expenditures in the last five years of life, and looked at these costs as a percentage of total household assets.  More than three quarters of households spent at least $10,000, with spending for all participants averaging $38,688 in the last five years of life.  Even more shocking was the fact that a quarter of participants made an average contribution of $101,791, and the same number spent more than their total household assets on healthcare.

Kelley and colleagues note that the amount spent on healthcare varied widely with the type of illness suffered, with dementia costing the most money.  Out-of-pocket spending for individuals or their spouses dying with dementia was more than twice the average for dying from gastrointestinal disease or cancer.  The majority of these costs are related to nursing home expenses which accounted for 56 percent of average spending in those suffering from Alzheimer’s disease.

Thus far, attempts to promote legislation to help with long-term care requirements have all been deemed too expensive.  Until someone comes up with a financially viable scheme, the authors speculate that the financial outlook for the elderly in coming decades is discouraging.  They conclude that, “as more baby boomers retire, a new generation of widows or widowers could face a sharply diminished financial future as they confront their recently-depleted nest egg following the illness and death of a spouse”.


1. Kelley AS, McGarry K, Fahle S, Marshall SM, Qingling D and Skinner JS (2012).  Out-of-pocket spending in the last five years of life.  Journal of General Internal Medicine. DOI 10.1007/s11606-012-2199-x.